communication - Lessons in Speech with Nanette

Best Practice School Assessment of Expressive & Receptive Language

Group of children sitting on the ground outside

Unlocking a child’s linguistic potential is at the heart of every comprehensive school assessment, particularly when it comes to evaluating expressive and receptive language skills. In this post, we delve into the best practices and methodologies employed by school speech pathologists to assess these vital components of communication development. From standardized tests to observational techniques, educators and speech-language professionals employ a range of strategies to gain a thorough understanding of a student’s language abilities. Join us as we explore the intricate process of evaluating expressive and receptive language skills in the school setting.

A language delay refers to a temporary lag or slower-than-typical development in a child’s ability to understand and/or use spoken language. My intent in writing this post on language delay was to provide some parent education on diagnostics. If your child has been found eligible for speech and language services because he or she has a language delay, then this finding was likely based on several factors.

STANDARDIZED EVALUATION:

One essential tool in determining eligibility for language services is a standardized evaluation, which would yield standard scores to assist in comparing your child’s results to his or her peer population. When a child is initially referred for language assessment, speech pathologists should conduct a comprehensive evaluation that includes all aspects of communication (medical history intake, hearing, vocabulary usage and comprehension, speech articulation, fluency, voicing, and expressive and receptive language.)

Sometimes, a teacher may notice a child struggling with understanding vocabulary or a parent may have difficulty understanding the sentences his/her child produces, but there could be other, contributing factors for these delays. To determine all areas needing intervention, speech pathologists must use a comprehensive test battery. Below are some examples of comprehensive language tests for preschoolers and school-aged children:

Preschool:

Clinical Evaluation of Language Fundamentals-Preschool- third edition (CELF Preschool-3)
Receptive-Expressive Emergent Language Test-third edition (REEL-3)
Rossetti Infant-Toddler Language Scale
Preschool Language Assessment Instrument- second edition (PLAI-2)
Preschool Language Scale- fifth edition (PLS-5)
Structured Photographic Expressive Language Test-Preschool- second edition (SPELT-P 2)
Test of Early Language Development- fourth edition (TELD-4)

School-aged:

Clinical Evaluation of Language Fundamentals- fifth edition (CELF-5)
Comprehensive Assessment of Spoken Language- second edition (CASL-2)
Fullerton Language Test for Adolescents- second edition
Functional Communication Profile (FCP-R)
Oral-Written Language Scale-2 (OWLS-2)
Test of Adolescent and Adult Language- fourth edition (TOAL-4)
Test of Language Development-Primary: fifth edition (TOLD-P:5)
Test of Language Development-Intermediate: fourth edition (TOLD-I:4)

When speech pathologists assess language skills, we also test expressive (use) and receptive (understanding) of vocabulary. Vocabulary delays can significantly impact language structure and use. Therefore, we need to evaluate vocabulary in determining if formal treatment goals are indicated. Here are some examples specific to vocabulary assessment:

Assessing Semantic Skills through Everyday Themes (ASSET)
Comprehensive Receptive and Expressive Vocabulary Test-third edition (CREVT-3)
Expressive One-Word Picture Vocabulary Test- fourth edition (EOWPVT-4)
Expressive One-Word Picture Vocabulary Test-Upper Extension (EOWPVT-UE)
Expressive Vocabulary Test- third edition (EVT-3)
Peabody Picture Vocabulary Test-fourth edition (PPVT-4)
Receptive One-Word Picture Vocabulary Test- fourth edition (ROWPVT-4)

INFORMAL OBSERVATIONS:

Other factors that help determine eligibility are informal observations. Speech pathologists may note how a child converses during less structured situations and transitions from one setting to another. An informal observation often includes a language sample analysis. Since language sampling is not a standardized test, it can be completed several times over the course of therapy to document progress.

Speech pathologists use language sampling to analyze a child’s conversational, open-ended speech. We strive to write down fifty sentences or utterances that your child produces during free play and then we calculate the mean length of utterance (MLU) or average number of words and structures used per sentence. During this sample, we refrain from asking questions; rather, we set up items within your child’s reach or ask them to discuss a few topics with minimal prompting. We also use language sampling to assess a child’s language form, content, and use.

PARENT REPORT:

Finally, the last component in determining eligibility is parent report. This unit of information is key since caregivers know their children best while examiners are only getting a brief snapshot of a child in a new setting. Caregivers can provide information pertaining to social skills development, self-care skills, and communication ability in a variety of settings.

Using formal assessment, informal observations, and a caregiver report, speech pathologists strive to develop a plan of care to address language deficits. These goals should be measurable and achievable within a year’s time. After a year, your child may continue to need support services, therapy frequency may need to be increased or reduced, or a discharge plan may be indicated.

To maintain test validity, we cannot repeat the same test battery with a child sooner than one year. While assessments are ongoing using logs and data charting at sessions, it is best practice to formally review goals with caregivers after one year of therapy. Schools require speech pathologists to rate progress on each goal on a quarterly or semester basis, while these reviews may happen more frequently with children receiving private services. There are four, main language areas that are evaluated and addressed as indicated: content, form, use, and understanding.

CONTENT:

Content refers to word meaning, otherwise known as semantics. We use semantics to construct phrases and sentences that make sense to others. This requires an ability to comprehend vocabulary terms and concepts such as multiple meanings, synonyms, and antonyms. Some children have difficulty learning vocabulary and using terms appropriately; therefore, clinical sessions would focus on teaching strategies such as categorization, associations, and graphic organizing (visual diagram that maps definitions, associative words, pictures and more) to improve both comprehension and word retrieval.

FORM:

Form is the process of attaching a symbol, such as a word, picture, or sign to the content/meaning. Form also refers to word ordering (syntax) in sentences and length (number of words) in sentences. Some children are challenged by constructing syntactically correct sentences that use an appropriate pattern such as, noun-verb-noun, or noun-verb-adjective-noun. These sessions would focus on practicing a variety of patterns appropriate for the child’s age and ability levels given visual supports (pictures) and/or verbal prompting. We may do this through worksheets, games, and computer programs.

There are a variety of applications for phones and tablets that we can recommend for home practice too. For example, Rainbow Sentences by Mobile Education Store is an app that works in levels and visual supports to teach putting words in order to construct sound sentences. During clinical sessions, we may also work on increasing the number of words in a production to include terms like adjectives or adverbs.

USE:

Finally, use refers to the many communicative intents:

Naming (ball)
Requesting objects (want bubbles), actions (go), assistance (help)
Responding to questions
Making comments (I like it)
Protesting (No more)
Attention seeking (Look!)
Greetings (hi/bye)

Often, caregivers are primarily concerned about their child’s limited speech production to request desired items, and naturally, caregivers spend time prompting children to “say” or “repeat” words to increase speech output. This method is not as successful in teaching words because imitation is not considered a communicative intent. We do not spend our days telling other adults what to say, so why tell our children? That is not to say that we do not have children repeat words to teach new vocabulary; rather, we find natural ways for them to say a word again.

For example, as a child looks towards a dog, we can start a communication exchange by saying, “Can you see that dog? That is a big dog. There goes the dog. Say, bye dog.” In this way, we just stimulated naming and greetings, and maybe after hearing “dog” four times, the child will naturally repeat the word. Our goal as communication professionals is to help your child use and understand a variety of intents while socializing with others.

UNDERSTANDING:

Language comprehension refers to one’s processing and understanding of verbal information. Speech pathologists formally assess receptive language skills by evaluating your child’s ability to perform tasks such as:

Following single step (Show me the ball), related (First, get your socks, then your shoes), and unrelated (Get your cup, then put away your coloring book) directions.
Identifying picture or word answer given choices for targeted questions about sentence structure (Point to: I can eat this); concepts (Point to the one who is big); and groups (Show me the two pictures that go together.)
Understanding questions (responding to a where question with the name of a place.)

I hope that this post helped provide some information about how speech pathologists assess and design treatment plans for children with language delays. Caregivers are one of the most vital members of their child’s special education team; therefore, it is essential that you are just as knowledgeable about your child’s needs and treatment strategies as any other team member. Your comprehension and support fuels and sustains your child’s progress.

SIX Ways to Improve Vocabulary

by Nanette Cote

Why is vocabulary improvement crucial in speech therapy, and what are six effective strategies to achieve this goal? Explore our comprehensive guide to discover practical techniques and activities tailored to enhance vocabulary skills in speech therapy sessions. Caregivers can help improve their child’s vocabulary by practicing categorization, association, using themed-units, identifying attributes, and understanding context clues together.

The title: speech pathologist is rather misleading as it implies that we only work on speech. Whether we work in private practice, hospitals, or school settings, speech pathologists address language delays just as much as speech and articulation disorders. One aim of this post is to enhance expressive and receptive vocabulary skills, considering comprehension’s significance for meaningful language use. Some children excel expressively but require receptive skill development. Others need more focus on expression. Still, others can show a delay in both areas. After formal evaluation, a therapy plan is designed to best meet your child’s needs.

CATEGORIZATION

fruit stand — Photo by Clem Onojeghuo on Pexels.com

There are a few strategies that we can use to help improve vocabulary skills. The essence of this work is to teach children how to store vocabulary concepts like a filing system. Categorization activities may involve asking the child to name or identify members of a target group. For example, three items that belong in a zoo group include: lions, tigers, and bears (oh my!) On the flip side, we can also ask the child to provide or find the category name for a group of its members. We address categorization skills every day in our functional routines when we put away groceries, laundry, and toys.

HOME ACTIVITY:

two paper tote bags — Photo by George Dolgikh on Pexels.com

I had the good fortune to work with some exceptional Speech-Language Pathologists early on in my career. During one of my observations, I watched students play a lively, category game using just brown paper lunch bags and small sheets of paper. This game can easily be adapted for children in 1st through 5th grade. If your child is younger and has a hard time reading, then you can always put pictures on the bags in place of words.

Before you begin, get at least 10 paper bags, and write the names of various category groups on each one. Then, make a list, using a small piece of paper or half of an index card, of 4-5 group members. For pictures on bags, create and attach them. Make groups like Colors challenging by listing specific members, not just primary colors.

This is how you play:

Have your child set up bags with category titles. Then, read category members aloud for your child to listen. Then, have your child take the paper and place it in the correct bag. At the end, I always go back and take a paper out of the bag and practice recalling category members. You can make it into a game by giving a point for every correct placement for the word list and a point for each member he or she can recall from the list.

ASSOCIATIONS

black car — Photo by Sarmad Mughal on Pexels.com

Word associations are another example of teaching a “filing” system for word retrieval. These word pairs express a relationship that comes in many forms such as:

Opposites (night and day)
Synonyms (large and big)
Part-Whole (wheel and car)
Attributes (yellow and bees)
Functions (sleep and bed)

THEMED-BASED UNITS

close up of leaves in autumn — Photo by BREAKS OUT on Pexels.com

Themed based units typically follow seasonal events, activities, and familiar sights throughout the year. You can even build categorization and association strategies using themed units. This approach can be effective because you teach what the child is exposed to in his or her everyday life, which can make these terms become more functional as the child can apply therapeutic learning naturally in other settings.

ATTRIBUTES

close up photography of different type of colors of paper — Photo by Pixabay on Pexels.com

Another strategy for improving vocabulary is teaching attributes for target words. Here, we incorporate games, worksheets, and homework lessons that focus on describing items according to their function or use, color, shape, and size. We can also use other senses like taste and touch to define words. In this way, we have taken one vocabulary word and taught up to six more while formulating definitions.

HOME ACTIVITY:

Here’s an association activity based on seasonal themes and incorporating attributes that you can do for each season of the year with your child.

SUMMER: First, make a yellow circle and write in the middle, “Things that make me think of summer.” Then, cut up to 10-15 strips of paper to make the rays for the sun. Finally, brainstorm associations together and write down answers on rays. Some associative words my son helped me come up with for this task included: pool, beach, lake, water, hot, heat, ice cream, sunscreen, vacation, and swim.

FALL: Create a tree with different colored leaves for association words: colors, windy, apples, pumpkins, football, leaves, Halloween, Thanksgiving, hayrides, and scarecrow.

WINTER: Use snowflakes for association words and form these into a giant snowball. Some suggested terms: cold, ice, snow, coats, hot chocolate, holidays, snowman, sledding, ice skating, and boots.

SPRING: Create a giant center to a flower and write these words on petals and stems: warm, crisp, rainy, bloom, flowers, green, jackets, growth, new, and muddy.

CONTEXT CLUES/ WORD PARTS (PREFIXES, SUFFIXES)

Utilizing curriculum vocabulary with older children poses challenges in language goals due to progress assessment difficulties in my experience. However, we can measure improvement in a child’s ability to interpret vocabulary meaning in context or demonstrate knowledge of word parts. One of my most treasured purchase from Teachers Pay Teachers (TpT) is product called: Context Clues Packet using Tier Vocabulary by Nicole Allison. It is engaging and comprehensive for both elementary and middle school students. I especially like having answer choices for determining vocabulary meaning in context because it teaches another strategy of eliminating less obvious selections.

As support staff, we are challenged with helping foster independence with our students. We will not be there during their classroom instruction or testing to provide cues and probes to increase comprehension, so we need to teach strategies for unaided success. Incorporating the above mentioned techniques into daily activities at home can significantly boost your child’s vocabulary development. Remember, even just reading together is a great way to expand language skills!

Transform Communication with the Power of Floortime

by Nanette Cote

Embark on a journey of discovery as we delve into the transformative power of Floortime in embracing a child’s natural play inclinations. A while back, an Instagram photo inspired me to invite the photographer for a guest post about child-led play. Sara Roberts is an ASHA certified Speech-Language Pathologist based in New York. She received training in Floortime while in graduate school at Queens College. Floortime’s foundations greatly benefit her work with children on the Autism Spectrum in Early Intervention, preschool, and elementary school settings. You can follow her on:

Instagram: https://www.instagram.com/slptree/
Teachers Pay Teachers: https://www.teacherspayteachers.com/Store/Slp-Tree

Do you know how to play with children on the spectrum?

Playing with a child that barely or does not at all acknowledge your presence can be intimidating. It can make you feel lost. I have seen many adults (myself included at one time) try to interact by asking questions and get nowhere.

“You’re playing with the animals?” … No response.

“Which one is your favorite?” … No response.

“Can I have a lion?” … No response.

Strategies such as Following the Child’s Lead, Parallel and Self Talk, and Expansion are KEY to working on joint attention, engagement, as well as language and play development.

Here is an example of what this looks like in action:

A child was playing with toy animal figures by silently standing the animals up and knocking them down repeatedly. I copied what he was doing while I modeled the words “up” and “down” both verbally and on his Augmentative and Alternative Communication Device (AAC). He did not pay too much attention to me, but he let me do it and he was being exposed to language (win!).

Then I added to his play idea by getting really animated when I said “down” and crashed the animals all over the table. This made him smirk and look up at me. We did the routine again and this time he imitated my crashing motion. After a few repetitions, I added the idea of the animals jumping over each other and he imitated that too! My hope is that he remembers this expanded play idea the next time the animal bin comes out and he will use the language I modeled for him.

Now what do you do with a child that does not play with toys?

A child was wandering the room and spinning around in circles. I copied him by spinning too while I modeled the word “spin.” After a few moments, I said “stop” loudly while I stopped spinning and put my arms up in the air. I kept repeating this, hoping that the child would establish eye contact with me and/or copy my action. He did not, so I copied his spinning and then fell to the floor while I said the word “down.” He never looked at me directly, but eventually he fell to the floor too! We kept repeating this until he let me hold his hands and we were playing a modified version of Ring Around the Rosie.

What about children who tend to focus on tactile stimulation?

Let us say a child is running his fingers along window blinds. First, copy his action by running your own fingers along the blinds next to him. Then narrate what you are doing with simple language such as “up, down” or “open, close.” After a few repetitions, expand on this idea by adding one new idea. For example, when the blinds close, you can say, “Goodnight!” and pretend to sleep. When the blinds open, you can say, “Good morning!” with an exaggerated stretch and yawn.

Let us say another child is running his fingers over a bumpy surface. Copy the action then narrate such as exclaiming, “Bump!” or saying, “bumpy, bumpy, bumpy” in a sing song voice. Then add a new idea such as introducing a toy car and having it drive over the bump.

These strategies may not give you results every single time, but you are exposing the child to language and different play ideas and that is always a success! Here is the bottom line when playing with children on the spectrum: copy what the child is already doing and then add to it! Sara Roberts, MA CCC-SLP

SEVEN Awesome Summer Toys to Enhance Communication

by Nanette Cote

Boy playing in the sand at the beach with his father

If you read my post on toy selection, then you already know the four important features that I consider in a toy for enhancing speech and language development. Since I am a big fan of summer, I thought I would share some of my favorite summertime toys to support communication development for some fun in the sun. You will find that my recommendations are free of noises, bells, and whistles, so no need to stock up on batteries or worry about recharging something.

New Sprouts Camp Out

New Sprouts Camp Out by Learning Resources is most appropriate for children between 2-5 years old. Here are some suggestions for building communication:

Expand your child’s pretend play skills while “roasting” a hot dog and marshmallow and then blow on these as they get “hot”.
Pack up all the goodies in the carry bag and bring it outside the next time you are going to roast marshmallows to help your child build longer play sequences and imitate actions.
Build comprehension by asking “Get/Give me” for designated objects.
Work on answering WHO, WHAT, WHEN, WHERE questions such as, “What do you do when you are hungry?”
Make comments about each item to model expanding speech development like, “I love eating roasted marshmallows!”

Smart Snacks Alpha Pops

Smart Snacks Alpha Pops from Learning Resources is appropriate for children 2 years and older. This toy collection contains a rainbow of make-believe frozen, Popsicle treats with uppercase & lowercase letters for learning matching, color recognition, fine motor skills and imaginative play. Below are some additional suggestions to foster fine motor and speech/language communication:

Pull apart all Popsicle sticks and hide them under dry beans, water beads, or any filling of your choice. Then, have your child build hand skills by pushing the pieces together as he/she locates matches.
Build phonemic awareness by asking your child to find the letters that make the sound “Buh.”
Increase speech skills by modeling sounds.
Talk about words that start with the targeted letter.

Pop up Pirate

The Pop up Pirate game is suitable for 3 years and older as there are some small parts. I typically incorporate a pirate-theme sometime in my summer speech and language lessons while we talk about the ocean and the beach.

Build sharing and taking turns by having children use a gesture, sound, or word to make a request for “Me,” “My turn,” or “It’s my turn.”
Ask questions with “yes” or “no” answers such as: “Did the pirate pop?” or “Is that a red sword?”
Increase following directions with “Take two swords” or “Get a yellow sword.”
Practice simple to complex speech by modeling “pop,” “more pop,” “I want more pop!”

Hydro Hoops

Hydro Hoops is a new water play toy that I have been using in my speech and language pool group sessions this summer. Recommended ages are for 5 years and older, but I have used it with supervision with children as young as 3 years old.

Practice turn taking and sharing during pool play.
Model making appropriate comments when children make and/or miss baskets.
Build social comprehension by asking a child to throw the ball to another.
Role-play initiating asking to join a game with others.

Ocean-colored Water Beads

Ocean-colored water beads! While the recommended age for these is 3 years and older, I have used them with children through 10 years. These make a great filler for sensory bin exploration! Here are some suggestions for objects that you can hide in a container of these delightful beads:

miniature ocean animals
Learning Resources Alphabet Popsicles
seashells
colored fish

Buckets

Using buckets in summer activities with young children not only provides entertainment but also serves as an effective way to develop comprehension and language skills. By giving children commands to place objects either inside or on top of the buckets, parents or caregivers can create engaging and interactive learning experiences. This activity allows children to follow simple to complex instructions, enhancing their ability to understand and express language while also promoting fine motor skills and spatial awareness. You can even build on this activity by using a variety of buckets such as:

one small and one large
castle-shaped
square and round
animal faces

Bubbles by Gymboree

I’m not going to even try to sugar coat my feelings here, you NEED Gymboree Bubbles! These bubbles last longer, require less solution, and float on water, providing both entertainment and physical activity for children. The one downfall is that you can’t offer your bubble wand to little ones for sanitary reasons so they can work on some oral motor coordination. However, children can still try and blow the bubbles in the air, which often is a good starting place for toddlers trying to learn how to blow a bubble anyways. Once you break open the bubbles, here are some speech and language suggestions:

Ask if your child wants a “big” or “small” bubble to work on concepts.
Count the bubbles as you pop them with your finger.
Sing a song about bubbles to build rhythm and prosody (intonation) for speech.
See if your child can round his lips to blow the bubbles in the air. If not, then squeeze those cute, little cheeks in a bit to help him.

While I have deemed these toys to be ones you can use in the summer, all the above suggestions could be used year-round. There are no definitive rules when it comes to play, except of course to have fun!!

A First Person Review of Versatile SPARK Cards

by Nanette Cote

It’s always exciting for me to review a product, especially one as versatile as SPARK Cards! I can appreciate the hard work involved in creating educational items and the effort needed in promoting the tool. This is an honest review of how I found benefit in using SPARK Cards for sequencing in my private practice.

SPARK Cards Pros

Over the years, I have used SPARK Cards in my home office and teletherapy sessions with good success across a wide variety of ages, abilities, and settings. Some of my favorite features include:

Durable cardboard cards with a gloss finish to withstand being handled by many, little hands
Ability to use a dry erase marker to bring attention to teaching concepts
Functional stories that support making connections to daily living
Detailed descriptions for each card in a sequence to make session planning easier for the busy SLP and facilitate generalization of skills in the home setting
Hypothetical problem solving probes for each topic
Appropriate for children as young as four years old through middle school-aged clients

Teletherapy

I used these cards in teletherapy in two, different ways. One of my clients is working towards sentence formulation for functional tasks, so I scanned and loaded the Going to the Library deck in sequential order so we could address his goal without taxing the activity with sequencing. This particular deck is my favorite in the collection because we can talk about the library year round. I also like that the library itself mirrors a dated one that has patrons returning and checking out books the old fashioned way by handing them to a librarian. It’s a nice way to compare/contrast past and present features. I added some humor to the activity by joking about seeing a ladder. We addressed answering yes/no questions and problem solving in a lighthearted way that I feel improves engagement and attention in any task.

The second way that I used the sequencing cards was via my document camera. Another virtual client needs to improve sequencing skills, so I took three at a time from the Making a Lemonade Stand deck to provide choices while addressing sequential ordering. The three cards with kitchen backgrounds are my favorite ones in this series because I could again work on comparing/contrasting room features in the pictures to my client’s kitchen. Making these kinds of connections helps strengthen memory skills and brings much more meaning to our language activity.

Recommendations

While I LOVE the convenient portability of the SPARK collection and ease at which I can store it in my ever growing therapy closet, I would like to see the cards enlarged a little. Some of the smaller features are missed in my office sessions as I cannot magnify or zoom in on the cards as I can online. There is just so much fabulous detail in each card, that I would be saddened if my clients missed them.

I would highly recommend SPARK cards for home practice of all the above-mentioned language skills. Even children working on articulation goals could utilize this product, especially those needing drills at the sentence/conversational level. Specifically, the acronym SPARK stands for the following language probes embedded in each sequencing deck:

Sequencing and sentence formulation

Predicting, problem solving, picture interpretation

Analyzing and answering ‘WH’ questions (WHO, WHAT, WHEN, WHERE)

Retelling a story and reasoning skills

Knowledge of basic concepts and vocabulary

This comprehensive, affordable product promotes improving language skills at home. Since my original review, the developers launched more decks. You can purchase your set at these links:

Original SPARK set 1

SPARK collection 2

SPARK Junior (appropriate for children 3 years and older)

Mastering Teletherapy for Early Intervention

by Nanette Cote

Mother with child in Teletherapy Session

By: Janet L. Courtney, MS, CCC/SLP

Founder and CEO of Lighthouse Therapy LLC

Lighthouse-therapy.com

I am excited to introduce Janet Courtney, CEO of Lighthouse Therapy LLC, a teletherapy company. With over 25 years’ experience, she’s passionate about mentoring and supporting others. You can find Janet’s blog at https://www.lighthouse-therapy.com/blog, contact her at Lighthouse at contact@lighthouse-therapy.com or call 888-642-0994.

Teletherapy for Early Intervention

“My son is two and he isn’t talking yet, is that normal?” “Our one-year-old doesn’t feed herself and has trouble holding a spoon, is that normal?” A teenage mom with a 2-year-old and a 3-year-old is feeling overwhelmed and doesn’t know how to handle her children’s bad behavior. All these scenarios are great examples of children who will benefit from teletherapy for early intervention. The federal Individuals with Disabilities Education Act, Part C, (IDEA) covers services for children and families from Birth through age 3. The Preschool Program of Part B covers children for ages 3 to 5 (Section 619). These programs mandate special education services to be provided to families and their children with developmental delays or disabilities.

Referrals

Who plays a role in spotting these issues in students? Referrals can come from different sources. Parents are usually the first to notice issues, but teachers or doctors may also notice delays. Seeking help is crucial as these services greatly impact a child’s development and future education. The first 5 years are critical for physical, social, communication, and academic development.

Referrals for Early Intervention or Preschool involve a team of professionals who create an Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). The team composition depends on the child’s needs. Together with parents, team members outline concerns and services for the child and family. An IFSP, in particular, involves the entire family, emphasizing education and consultation. The program also sets goals related to the child’s development.

Groundwork for Success

Some parents and professionals may question how telepractice can meet children’s needs online and if it’s effective. Will it really work? How can therapists gather data for eligibility without being physically present? These are valid concerns that need addressing, especially regarding Early Intervention (EI) and Preschool services provided through telepractice. When a child is referred for these services, developmental assessments and parent/teacher questionnaires play a crucial role in understanding the child’s functioning. These assessments and interviews can be conducted via telephone or through the telepractice platform, often sent electronically. Lighthouse Therapy’s platform ensures safe and confidential sharing of information, reducing the risk of exposing Personal Health Information.

Online Video Conferencing

Portrait of cute girl listening to music on headphones while using laptop at home

Therapy sessions are conducted via online video conferencing, allowing flexibility for sessions in the child’s home or preschool classroom. Clinicians coach parents on targeted strategies, observe progress, and adjust techniques accordingly. In preschool, a support specialist or assistant aids the child in joining sessions. Through engaging activities and documentation cameras, therapists monitor and guide students effectively. Lighthouse Therapy’s platform is adaptable, ensuring a dynamic experience for all involved.

Parent Coaching in Teletherapy for Early Intervention

As therapists, it’s crucial to communicate clearly with parents and caregivers, offering practical strategies to enhance communication and learning at home. We teach parents how to emphasize key messages and directions, provide repetition and modeling for the child, and encourage recording interactions to track progress over time.

Wondering how to make teletherapy sessions successful for young children? SLPs plan multiple activities for a 30-minute session to maintain engagement. Themes, interactive videos, picture activities, and memory games keep sessions lively. Using stamps, drawings, and show-and-tell encourages communication skills.

For a FREE ebook that details parent coaching, please subscribe below:

Developmental Links

It is important for the professionals to have access to developmental norms, so I have included a couple links:

Many areas of the country desperately need these services. Engaging telepractitioners will provide key services crucial to children’s future academic success.

FAQ: Playing with Water in Speech Pool Groups

by Nanette Cote

In December 2015, the ASHA Leader honored me in their Limelight section. Months later, emails flooded in with excitement and questions about playing with water in speech pool groups. Messages from SLPs globally, including Germany, and locally, such as Illinois, have been received and appreciated. In true SLP fashion, professionals asked poignant questions, inspiring a FAQ post about speech and language pool groups. This post later turned into a guide book: We Talk on Water (available on Amazon.) For detailed guidance on lesson plans, materials, billing, participant recruitment, documentation, and low-tech AAC, this book is essential!

FREQUENTLY ASKED QUESTIONS ABOUT SPEECH
AND LANGUAGE POOL GROUPS

Coursework and Training

How did you got started in doing treatment sessions in the pool? In 2003, I observed a pool group at a Jewish Community Center in Rhode Island. Soon after, I requested insurance coverage. It took a couple months before my job site hosted speech and language pool groups at the Jewish Community Center. My tasks were promoting the pool group, collaborating with a PT, and writing weekly service notes for billing submission.
Do you have any special certifications to help with your sessions in the pool? I acquired all of my training through experience. Hosting my first pool group with an exceptional PT taught me about water positioning and improving stability and attention.
Is there coursework or training for providing aquatic speech therapy services? One of the emails that I received following the ASHA Leader article was from Susan Nachimson who shared that she has been teaching a course titled: Speech Therapy in an Aquatic Setting since 1/2002 [California Board of Speech Pathology (PDP#129)].

Securing a Facility

How would I go about looking for other facilities that offer aquatic speech therapy services? If you are not interested in starting your own group and would rather observe pool group therapy, then begin by calling rehabilitation facilities. Many of these locations have heated pools that they use for physical therapy with clients.
How did you secure the pool? Six months before the services were slated to begin, I actively researched for the pool group session I wanted to offer through my private practice. First, I called three facilities and ask to speak with the aquatics directors. I followed up by meeting receptive individuals who rented their pool to rehabilitative agencies. I chose Rush Copley Healthplex
Do you think a neighbor’s pool with an outside shower and bathroom work? I’m not a strong swimmer, so I’d feel uncomfortable using a neighbor’s pool and taking on liability for the group. I also like being in the community and being able to offer pool group services to up to 10 families. Having the ability to invite several participants also increases opportunities for peer modeling and expands socialization.

Billing, Insurance, and Liability Coverage

Do you bill for it like a normal group speech therapy session? Yes, I bill my speech and language services using the speech group CPT code 92508. This code is an “un-timed” one, meaning that you can expect the same reimbursement whether you spend ten minutes in the water or sixty.
Did you bill to insurance companies or do the group sessions private pay? If you did private pay, what were your rates? I do a little bit of both depending on the insurance carrier and my network participation. I advise families with high co-payments near reimbursement limits not to use coverage, to avoid taking away sessions. Research insurance reimbursements and set charges accordingly, ensuring rates align with coverage and state regulations. You can expect to make significantly less for group services than for individual sessions.
How did you go about getting liability coverage to work with clients in the pool? I asked the pool facility what they required and in my circumstance, I only needed to add the location name to my existing liability policy. This addition did not require any additional fees. You should ask this question while researching pool facilities as this may vary depending on your state.
Do you pay pool rental fees? There are non-refundable pool rental fees at the facility that I use for group services; however, I ask families to cover these costs. Families are expected to pay a designated amount per group for each of the six weeks of my program. This fee is not prorated if they miss a session. I cannot afford the risk of paying for weekly services for each family without being able to bill for a session if the family misses or decides not to continue for whatever reason.

Goals and Session Outline

Do you have specific goals for each child while playing with water or is it more a general group therapy targeting various aspects of language (engagement, imitation, vocalizing, following directions)? Years ago, an EI PT and I devised a service form for pool group tasks, now adapted for my private practice. New students are offered a free consultation to align goals. I designed the SOAP note to allow me an opportunity to comment and expand on tasks and I used a local printing store to make carbons of the note so I can quickly provide families with feedback about the session. I also wrote an outline of all the developmental goals that you can address with children aged two through seven years old during pool group therapy.
Have you ever used pool therapy for middle school and high school students with autism? And if, what kind of activities did you do? No, I have only worked with children aged 2-7 in the pool.
Would you mind sharing more details about a typical pool therapy session? For more details about my group agenda, you can follow this link.
What songs do you use in pool groups? The most popular songs are: The Wheels on the Bus, If you’re Happy and You Know it (I use this tune for a directions game to sing, “Put the duck on your head, on your head”), Head, Shoulders, Knees, and Toes, Five Green and Speckled Frogs, Hello and Goodbye songs, All the Little Fish were Swimming in the Water, One Little, Two Little, Three Little Bubbles.

Other

Did you have an ongoing day/time for a number of weeks? Yes, my summer groups are weekly at the same day and time for six weeks total.
Did you have the parents in the pool too? A caregiver at least 18 years of age is required to remain with each child before, during, and after pool group sessions.
Were your classes 30 min or one hour? My water sessions are 30 minutes long, but “therapy” begins in the changing room both before and after water play. We talk about our sessions, what we wear in the water, and temperatures that day just to name a few.
Did you co treat with a PT? I currently work as a solo facilitator for my pool group sessions, but highly recommend working with a motor specialist when possible, especially if you are just getting started with pool group therapy.
How do you advertise (word of mouth, flyers at your clinic, etc.)? I bought local ad space but got no clients. Last summer, participants found me on social media, through ABA meetings, and referrals.

Effective Writing for Students with Disabilities

by Nanette Cote

Honored to have Dr. Karen Dudek-Brannan, Ed.D. CCC-SLP, on the blog! With 10+ years’ experience, she’s worked in various settings, supervised students, and taught college courses. Dr. Karen currently works in the school systems and runs a website with innovative resources for treating language disorders with an emphasis on metacognition. This post will focus on effective writing strategies for upper elementary students with speech and language disabilities.

Understanding How Language Disabilities Influence Writing

We need to write for communication, academic purposes, and professional advancement, yet many adolescents and young adults fail to develop sufficient writing skills when they are in school (Graham & Perin, 2007).

This is often the case for students with disabilities that impact language. Students with language delays tend to have poor metalinguistic and metacognitive awareness. They have a poor understanding of how their brains work, which makes planning, writing, and revising difficult (Graham, Schwartz, & MacArthur, 1995). Students with language and learning problems struggle to plan and generate ideas during the planning/brainstorming phase of writing (Chalk, Hagan-Burke, & Burke, 2005). Many educators end up asking students probing questions to provide support, but doing this may make students become prompt-dependent.

Enhancing Writing Skills with EET Visuals

To help students become independent, we need to show them how to self-regulate and self-question. Self-regulation strategies may involve mnemonics or memory tools to help students remember the steps of the writing process. Tools which guide students through protocol steps or self-questioning techniques can improve word-retrieval and executive functioning, which positively impacts idea generation. Use of these tools can improve organization, fluency, transitions, as well as conventions of writing for students with and without disabilities (Graham, & Perin, 2007; Little, Lane, Harris, Graham, Story, Sandmel, 2010). When used effectively, self-monitoring and self-questioning tools can provide the structure necessary to help students complete steps of the writing process independently.

EET Toolkit

One specific tool for self-questioning is the Expanding Expression Tool (EET; Smith, 2011).

The EET incorporates a mnemonic device to help students to recall semantic information about nouns. The mnemonic for the EET is twofold; as students can use a chant or a visual aide to recall questions they should ask themselves when generating ideas to write. The visual aid is a strand of color-coded beads.

Each EET bead stands for a specific question. Here is a graphic to help illustrate how the beads correspond with the questions and EET cues, as well as an example of how you would use the EET to describe the word “apple.”

The second aspect of the EET mnemonic is the chant. Students can say a chant aloud or internally to help remember the questions with or without the EET strand present. To say the chant, the students simply say or sing the beads in order: “Green group, blue do, what does it look like, what is it made of, pink parts, white where, what else do I know?” (Smith, 2011).

In order to effectively utilize a metacognitive strategy such as this, we need to show students how to use it. This often involves explaining the purpose of the strategy, modelling, and providing opportunities for both guided and independent practice (Chalk et al., 2005; Ukrainetz, 2007).

Helpful Protocol

I’ve developed protocol you can use to teach students self-questioning strategies that incorporates all necessary components (e.g., rationale, modeling, guided practice, independent practice) to assist in the planning phase of the writing process (Dudek, 2014). This protocol would be appropriate for students ranging from early elementary through high school; however you will be able to modify the level of difficulty by the content you describe.

Here is a graphic illustrating what to do in each step. This can be completed in one session, or over several consecutive sessions.

One More Example

Now that you have seen the steps in the process, here is another example of the type of information that would correspond with each question on the EET strand. This sample shows how a student’s notes may look after the brainstorming process. As you can see, there are two pieces of information per EET question; however one could use this process to provide more detail if needed. This content would be appropriate for students in middle school writing an expository piece about the Midwestern region of the United States.

The purpose of metacognitive strategies during the writing process is to improve the quality of writing and autonomy. By teaching students to use strategies, we can help our students become more aware of how they learn and process, so they can become independent writers.

Resources and References

For more information on the EET you can visit www.expandingexpression.com.

For additional resources on metacognition and language visit www.drkarenspeech.com.

Chalk, J.C., Hagan-Burke, S., & Burke, M.D. (2005). The effects of self-regulated strategy development on the writing process of high school students with learning disabilities. Learning Disability Quarterly, 28,75-87. doi: 10.2307/4126974

Dudek, K. (2014). The effect of metalinguistic strategy instruction on the oral and written expression of school-aged children. (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (Accession Order No. 3623397).

Graham, S. & Perin, D. (2007). A meta-analysis of writing instruction for adolescent students. Journal of Educational Psychology, 99,445-476. doi: 10.1037/0022-0663.99.3.445

Graham, S. Schwartz, S., & MacArthur, C. (1995). Effects of goal setting and procedural facilitation on the revising behavior and writing performance of students with writing and learning problems. Journal of Educational Psychology, 87, 230-240.

Little, M.A., Lane, K. L., Harris, K. R., Graham, S., Story, M., & Sandmel, K. (2010). Self-regulated strategies development for persuasive writing in tandem with schoolwide positive behavioral support: Effects for second-grade students with behavioral and writing difficulties. Behavioral Disorders, 35, 157-179.

MidWest. (2016, February 20). Retrieved from http://www.encyclopedia.com/topic/Midwest.aspx

Smith, S. L. (2011). Expanding expression: A multisensory approach for improved oral and written language (2nd Ed.). Bay City, MI: Expanding Expression.

Ukrainetz, T. A. (2007). Contextualized Language Intervention: Scaffolding PreK-12 Literacy Achievement. Austin, TX: Pro-Ed.

Not-so-Spooky Halloween Activities for the Young at Heart

by Nanette Cote

Fall is one of my favorite seasons, with the changing colors, cooler days, slower pace, and holidays abound. I transform my office and set up not so spooky Halloween activities for the young at heart for at least six weeks! Let’s take a closer look at some easy and affordable ways you can transform any space for fun and functional learning.

DECOR

Over the years, I have purchased many Halloween decorations at the end of the season clearance sales at Target and Walmart. I also collect seasonal items at the Dollar Tree for both crafts and decor. These materials help me to transform my office space into a fun, brightly-colored theme that usually brings a smile to a client’s face upon entering. Some of my typical decor lasts for a few years or more. I decorate with Halloween-themed items like a plastic cloth, banner, haunted houses for storage, and a bucket of books. The vibrant decor prompts clients to comment and label objects, enhancing engagement during therapy sessions.

A clearance door covering with removable stickers from Target was a favorite find, providing enjoyment for clients for years. The stickers were easily removable, allowing multiple clients to enjoy the task over several years. We worked on following directions like, “Put five pumpkins on the fence”, “Give each pumpkin and ghost a hat”, “Put the bat on the moon/window” and “Put the pumpkin on the ghost.” I liked that I could work on familiar and novel commands and vary this activity to meet the needs of many clients.

My Halloween book collection, mostly my son’s, is extensive, as seen below. I use them for sequencing tasks with clients. Manipulatives purchased from various sellers enhance language tasks with the books during sessions. Having these hands-on activities while reading books dramatically improves attention, which in turn increases word ordering sentences and responding to questions about the story. You can find some wonderful materials at these locations:

PUMPKIN CRAFT

Another huge hit every year is my Styrofoam pumpkins craft with plastic facial parts all courtesy of the Dollar Tree. We use this in language sessions to make requests with complete sentences like “I need a mouth” or “I want eyes.” This task is especially perfect for my young language learners using speech generating devices.

Everyone enjoys taking these home and recreating it. Some caregivers commented that they liked this activity so much that they purchased more pumpkins and facial parts on their own and made them with siblings at home. I love it when something that we talk about in the speech room can be generalized to other settings!! What a great way to practice functional and seasonal vocabulary and language skills!

SCARECROW SNACK

One sure way to a child’s heart is food! We have made a scarecrow treat to practice sequencing, commenting, and requesting. I found this creative snack in a Pillsbury Halloween cookbook that I bought years ago when my son was a mere toddler. You can see the steps in the images below if you want to make your own, yummy snack sometime.

First, spread white icing on a vanilla cookie.

Second, shred some Triscuit crackers to make straw.

Place shredded crackers on the sides of the cookie.

Add a candy corn nose.

Use chocolate chips for eyes and black icing for a mouth.

Add a gumdrop hat and then enjoy your treat!

PLAYDOUGH

Many of my activities for little ones between the ages of 2-7 include hands on play and sensory time. A fan favorite is play dough. I make my own batch for individual clients using this recipe that is quick, inexpensive, and easy. When I want to move on to another color, I send the play dough home with the client and whip up another batch.

One time, I accidentally stumbled upon an activity to work on sound sequencing using play dough and mini erasers/ objects. You do not need to practice the names of the characters on the erasers, unless you want to. My clients primarily worked on sequencing simple CV, VC, and CVCV combinations, so we used individual targets while pushing the object into the dough. I’m telling you, we could spend half of the hour long session just playing with dough!

SENSORY BINS

Speaking of sensory play, I also love switching out a basket or bin for seasonal activities. We have practiced sounds and words while digging through a bin filled with leaves in September and then hunted for targets in a Halloween-themed bin in October. Near Thanksgiving, I mixed Velcro foods with fake gourds to target CVC words like “cut”. I find much of my fill for these sensory bins at the Dollar Tree and typically throw away what I cannot sanitize and just buy new fill the next season.

Fall

Halloween

Thanksgiving

LEGOS

I usually have a couple upper elementary students working on articulation of (you guessed it) /s/ or /r/!! These clients have loved earning a Lego brick each time they practiced a target. Once all targets were earned, clients were given some time to create a Halloween character. Kids are so much more creative than I am when it comes to crafts, so I rely on them to make a masterpiece without laying out a predetermined plan. Here is what my a fifth grader conjured up: can you tell he loved Minecraft?

I hope you enjoyed this fall post and found a new resource or two for your speech sessions! Incorporate these not-so-spooky Halloween ideas into your therapy sessions, creating a fun and engaging atmosphere for speech and language development.

Six Opportunities for Modeling on AAC Devices to Support Communication

by Nanette Cote

Why you should model language on AAC communication devices: Unveiling the transformative impact of this crucial practice in enhancing communication skills. This post will help you discover how AAC communication devices facilitate communication growth, enabling users to engage in requesting, greeting, turn-taking, commenting, protesting, and responding.

SGD and AAC

Speech generating devices (SGD) are an electronic augmentative and alternative means of communication (AAC) for people with limited verbal ability. These devices can be used to augment someone’s speech that may be difficult to understand or as an alternative to speaking to make one’s needs known. Considering so many options available, experts recommend a selective and comprehensive team approach for determining which device to trial. I have joined school team meetings, aiding young clients in selecting a speech device. Witnessing their newfound communication skills fills me with joy.

Initially, we want the child to explore and feel ownership with an SGD, but it is just as important to model language on these devices as well. I have often heard parents comment that their children do not like having anyone else touch their devices. Respect their ownership, but let your child know you also need to touch the device to help them learn. Simply modeling verbally is not enough; you must also show your child how to navigate to words not on the initial screen page.

Model to Expand Communication

In my experience, most children begin using an SGD to request food and toys, which are tangible reinforcements for making your needs known. This can certainly support wanting to use a device again given the benefits. We often forget to model other communication intents beyond requesting, assuming a child will demonstrate them independently. Communication extends beyond “Ask and you shall receive.” We must demonstrate all aspects of engaging with others to our children. I’ll describe six communicative intents with examples for direct modeling on your child’s device. Teach diverse communication and guide children on SGDs to map and locate words effectively for various exchanges.

Requesting

In the opening of this post, I presumed that your child has already reaped some rewards in requesting foods/ toys using an SGD. That does not mean that we check the box on making requests, rather we expand on it. Using your child’s age and ability as guides, model simple phrases and/or sentences. A two-year-old or early language learner may find “I want a cookie, please” too complex without prior phrase development. A better option would be modeling “more cookie” or “no cookie.”

Greetings

This is a great way to elaborate on greetings beyond a wave hello and goodbye. Navigate to your child’s “people” page and model, “Hi, Nanette” or “Bye dad.” Go ahead and say hello and goodbye to toys as you take them out or clean up.

Turn taking

Asking for a turn using a word like “me” or combinations such as “my turn” adds variety to requests. It prevents overreliance on the device for food requests. You can model these during play or game time. This simple act is more powerful than you would think. Remember that the whole purpose of communication is rooted in taking turns to say or do something. Lay this foundation as soon as possible to open more doors to communicating with your child.

Commenting

Limit labeling items using “I see an apple” since it is not natural for us to walk into a room and start making these statements. Rather, teach sentences such as “I like this apple,” or “This apple is good.” Remember to model in the language structure appropriate for your child.

One fantastic opportunity for modeling comments is during shared book readings. Instead of reading your child’s favorite book to him, read it with him using his device by modeling things like, “Uh Oh,” “That’s silly,” “Oh no!” and “Great!” to make a variety of comments. Here is a video of an autistic youngster who mastered commenting independently with a Pete the Cat book.

Protest

Yes, I want you to teach your child to protest, but in a socially appropriate way using words and/or phrases. Model saying “no”, “mine” and “all done” and praise independent usage of making needs known. If your child routinely uses these to escape work activities, solidify responses. Then, explain it’s time to work first or offer another choice.

Respond to questions

Teach how to answer WHO, WHAT, WHEN, WHERE, and WHY questions using words, phrases, then simple sentences. You can model further by elaborating with descriptive words like, “It looks yellow.”

I have become most familiar with the Nova Chat SGD, which allows you to program information about something that happened during the school day and/or over evenings and weekends at home. So, when asked, “What did you do in school or at home?”, your child can learn to navigate to the page with this information to respond to these questions. A client collaborated with her school SLP to learn answering “All About Me” questions, a wonderful, functional communication method.

I hope that this post provided some specific examples of modeling a variety of communication intents on your child’s speech generating device. These early conversation starters lay a foundation for expanding language skills and developing social connections. Do not hesitate to get your hands on your child’s device and teach them these skills through modeling. You will amaze yourself at all the doors you open for communication.